覆膜支架腔内修复处理降主动脉破裂的临床体会

目的总结运用胸主动脉覆膜支架腔内修复急诊救治降主动脉破裂的经验和体会。方法回顾分析2013年5月~2017年3月我科收治降主动脉破裂患者16例,其中胸主动脉夹层动脉瘤破裂14例,感染性假性动脉瘤致降主动脉破裂1列,不明原因的食管降主动脉瘘1例。16例患者术前均通过胸腹主动脉计算机断层血管造影(Computed tomography angiography,CTA)明确诊断,均在急诊全麻下经股动脉入路行胸主动脉覆膜支架腔内修复术(Thoracic Endovascular Aortic Repair,TEVAR)。结果 16例患者均顺利完成手术。其中1例患者术后因血流动力学不稳定死亡,1例患者术后急性肾功能衰竭死亡,余14例患者均痊愈出院,未发生截瘫、逆撕、肢体缺血等相关并发症。无术中中转开胸手术。结论胸主动脉覆膜支架腔内修复是急诊救治降主动脉破裂的有效方法,尽早进行急诊手术是抢救的关键。

Clinical experience of endovascular stent graft repair of descending aorta rupture

Objective To summarize the experience of using thoracic endovascular aortic repair for emergency treatment of descending aorta rupture.Methods 16 cases of descending aortic rupture in our department from May 2013 to March 2017 were retrospectively analyzed.Among them,there were 14 cases of thoracic aortic dissection aneurysms rupture,1 case of aortic rupture caused by infectious pseudoaneurysms,and 1 case of the esophageal descended aorta fistula with unexplained causes.All 16 patients were diagnosed by thoracic-abdominal aorta computed tomographic an giography(CTA)before surgery.All patients underwent thoracic endovascular aortic repair(TEVAR)under emergency general anesthesia by transfemoral approach.Results All 16 patients successfully completed the operation.One patient died of hemodynamic instability after surgery,and one patient died of acute renal failure after surgery.The remaining 14 patients were fully discharged.No complications such as paraplegia,reverse tear,and limb ischemia occurred.There was no intraoperative thoracic surgery.Conclusion Thoracic endovascular aortic repair is an effective method for emergency treatment of descending aorta rupture.Emergency surgery as soon as possible is the key to rescue.